The invention relates to a medical puncturing device for penetration into a bone or a cartilage.
A medical puncturing device in the form of a cartilage punch is known, for example, from DE 10 2005 010 988 A1.
With such a punch, an area of the cartilage-like periosteum can be punched out from a bone surface. This is done if the periosteum has a defect, for example, and if this defect site has to be repaired, for example by fitting a suitable implant.
Defect sites of this kind occur particularly in joints where two opposite bones rub against each other. In healthy joints, a corresponding layer of cartilage is located between the bones, and also a cartilage fluid that lubricates the movement of the two bones on each other.
If this synovial fluid is no longer present, either because of injuries or sometimes also because of aging, the bones rub directly on each other via their cartilage or via the outer periosteum thereof. Very painful defects then arise at the contact sites.
To rectify the defect, a flat piece of the periosteum is first of all punched out in the area of the defect using a puncturing device in the form of a punch that has a distal cutter. The shaft of the puncturing device is hollow, such that the punched-out piece of periosteum can be removed through the shaft. For the subsequent successful fusion of an implant, it is very important that the cut provided by the circumferential cutter is made with a cut edge that is as straight as possible, particularly with a cut edge that extends perpendicularly with respect to the surface described by the cutter.
A medical puncturing device in the form of a microfracture chisel is known from DE 10 2005 010 989 A1.
This puncturing device has a plurality of studs or tips projecting from the distal end. These are designed to introduce microfractures into a bone. By means of these microfractures, a clot permeated with pluripotent stem cells from the bone marrow can be generated. Such a clot is also sometimes known as a “super clot”. The stem cells contained in this clot can differentiate to cartilage cells in the course of the healing process and form new cartilage tissue. That is to say, this microfracture chisel can likewise be used in the repair of cartilage defects on bone.
For example, after the periosteum in the area of the defect site has been removed using the punch mentioned in the introduction, a multi-microfracture chisel can be used to create such a clot, which then replaces the cartilage at the punched-out site.
It has also been found that the fusion of an implant fitted at the punched-out site is greatly accelerated by such clots.
A common aspect of both tools is that, during handling, a force has to be applied along the longitudinal axis of the shaft, either to press the cutter of the punch into the cartilaginous tissue or to drive the multi-microfracture chisel into the bone.
The fact is, however, that such defect sites mostly occur quite far inwards in the area of joints, particularly in the area of the knee joint, that is to say at a location that is quite difficult to access using a rectilinearly extending and rigid shaft. The joint then has to be bent or spread to an extreme in order to access such locations.
Therefore, the object of the present invention is to remedy this situation and to improve a puncturing device of the type mentioned at the outset in such a way that it is also possible to reach locations that are quite difficult to reach in joints, in order to repair a defect site there.